[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 9941 Introduced in House (IH)]
<DOC>
119th CONGRESS
2d Session
H. R. 9941
To protect and expand nationwide access to assisted reproductive
technology, including in vitro fertilization.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
July 23, 2026
Mrs. Trahan (for herself, Ms. DeLauro, Ms. Gillen, Mr. Larsen of
Washington, Mr. Walkinshaw, Mr. Amo, Ms. Ansari, Mr. Auchincloss, Ms.
Barragan, Mrs. Beatty, Mr. Bell, Ms. Brownley, Ms. Budzinski, Ms.
Bynum, Mr. Carbajal, Mr. Carson, Mr. Carter of Louisiana, Ms. Castor of
Florida, Ms. Chu, Ms. Clarke of New York, Mr. Cleaver, Mr. Cohen, Mr.
Courtney, Ms. Craig, Ms. Crockett, Mr. Davis of Illinois, Ms. DeGette,
Ms. DelBene, Mr. Deluzio, Mrs. Dingell, Ms. Elfreth, Ms. Escobar, Mr.
Espaillat, Mr. Evans of Pennsylvania, Mrs. Fletcher, Mr. Foster, Mrs.
Foushee, Ms. Lois Frankel of Florida, Ms. Friedman, Mr. Frost, Mr.
Garamendi, Mr. Garcia of Illinois, Ms. Garcia of Texas, Mr. Gottheimer,
Mrs. Grijalva, Mrs. Hayes, Ms. Houlahan, Mr. Hoyer, Ms. Hoyle of
Oregon, Mr. Ivey, Mr. Jackson of Illinois, Mr. Johnson of Georgia, Ms.
Johnson of Texas, Ms. Kamlager-Dove, Ms. Kelly of Illinois, Mr. Kennedy
of New York, Mr. Khanna, Mr. Larson of Connecticut, Mr. Latimer, Ms.
Lee of Nevada, Ms. Leger Fernandez, Mr. Levin, Mr. Lieu, Mr. Lynch, Mr.
Mannion, Ms. Matsui, Mrs. McBath, Ms. McBride, Mrs. McClain Delaney,
Ms. McClellan, Mr. McGarvey, Mr. McGovern, Ms. Mejia, Mr. Menendez, Ms.
Moore of Wisconsin, Mr. Morelle, Ms. Morrison, Mr. Moulton, Mr. Mullin,
Mr. Nadler, Ms. Norton, Ms. Ocasio-Cortez, Mr. Olszewski, Ms. Pelosi,
Mr. Peters, Ms. Pettersen, Ms. Pingree, Mr. Pocan, Ms. Pou, Ms.
Pressley, Mr. Quigley, Mrs. Ramirez, Ms. Randall, Mr. Riley of New
York, Ms. Ross, Mr. Ryan, Ms. Sanchez, Ms. Scanlon, Ms. Schakowsky, Mr.
Schneider, Ms. Schrier, Mr. Smith of Washington, Mr. Soto, Ms.
Stansbury, Mr. Stanton, Ms. Stevens, Mr. Takano, Mr. Thanedar, Ms.
Titus, Ms. Tlaib, Mr. Tonko, Mrs. Torres of California, Mr. Torres of
New York, Mr. Tran, Mr. Veasey, Ms. Velazquez, Mr. Vindman, Ms.
Wasserman Schultz, Ms. Williams of Georgia, Ms. Wilson of Florida, Mr.
Horsford, and Ms. Meng) introduced the following bill; which was
referred to the Committee on Energy and Commerce, and in addition to
the Committees on Veterans' Affairs, Armed Services, Education and
Workforce, Ways and Means, and Oversight and Government Reform, for a
period to be subsequently determined by the Speaker, in each case for
consideration of such provisions as fall within the jurisdiction of the
committee concerned
_______________________________________________________________________
A BILL
To protect and expand nationwide access to assisted reproductive
technology, including in vitro fertilization.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Right to IVF Act
of 2026''.
(b) Table of Contents.--The table of contents for this Act is as
follows:
Sec. 1. Short title; table of contents.
Sec. 2. Severability.
TITLE I--PROTECT IVF
Sec. 101. Short title.
Sec. 102. Purposes.
Sec. 103. Definitions.
Sec. 104. Right to assisted reproductive technology rights and
Intrauterine insemination rights.
Sec. 105. Applicability and preemption.
TITLE II--VETERAN FAMILIES HEALTH SERVICES
Sec. 200. Short title.
Subtitle A--Reproductive and Fertility Preservation Assistance for
Members of the Uniformed Services
Sec. 201. Definitions.
Sec. 202. Provision of assisted reproductive technology, intrauterine
insemination, and counseling to certain
members of the uniformed services and
spouses, partners, and gestational
surrogates of such members.
Sec. 203. Establishment of fertility preservation procedures for
members of the uniformed service on active
duty.
Sec. 204. Assistance with and continuity of care regarding reproductive
and fertility preservation services.
Sec. 205. Coordination between Department of Defense and Department of
Veterans Affairs on furnishing of assisted
reproductive technology, intrauterine
insemination, and counseling.
Sec. 206. Regulations.
Subtitle B--Reproductive Assistance for Veterans
Sec. 211. Inclusion of assisted reproductive technology, intrauterine
insemination, and counseling under the
definition of medical services in title 38.
Sec. 212. Assisted reproductive technology, intrauterine insemination,
and counseling for certain veterans and
spouses, partners, and gestational
surrogates of such veterans.
Sec. 213. Assistance with and continuity of care regarding reproductive
and fertility preservation services.
Sec. 214. Coordination of reproduction and fertility research for
veterans.
TITLE III--ACCESS TO ASSISTED REPRODUCTIVE TECHNOLOGY AND INTRAUTERINE
INSEMINATION
Sec. 301. Short title.
Sec. 302. Standards relating to benefits for assisted reproductive
technology or intrauterine insemination.
Sec. 303. Requirement for State Medicaid plans to provide medical
assistance for assisted reproductive
technology and intrauterine insemination.
Sec. 304. Medicare coverage of assisted reproductive technology and
intrauterine insemination.
TITLE IV--FAMILY BUILDING FEHB FAIRNESS
Sec. 401. Short title.
Sec. 402. Assisted reproductive technology and intrauterine
insemination benefits.
SEC. 2. SEVERABILITY.
If any provision of this Act, or the application of such provision
to any person, entity, government, or circumstance is held to be
unconstitutional, the remainder of this Act, or the application of such
provision to all other persons, entities, governments, or circumstances
shall not be affected thereby.
TITLE I--PROTECT IVF
SEC. 101. SHORT TITLE.
This title may be cited as the ``Protect IVF Act''.
SEC. 102. PURPOSES.
The purposes of this title are as follows:
(1) To permit patients to seek and receive assisted
reproductive technology (ART), including in vitro fertilization
(IVF), and intrauterine insemination (IUI), and to permit
health care providers that choose to provide ART or IUI to
provide such services, by ensuring that States will not enact
harmful or unwarranted limitations or requirements that single
out the provision of ART or IUI for restrictions that are not
consistent with American Society for Reproductive Medicine
guidelines and that do not significantly advance reproductive
health or the efficacy and safety of ART or IUI, or that make
ART or IUI more difficult to access.
(2) To promote the right and ability of an individual
residing in any State to choose to receive ART or IUI provided
by a health care provider who chooses to provide such services.
(3) To protect an individual's right to make decisions, in
consultation with the individual's health care provider, about
the most appropriate medical care to maximize the chance of
becoming pregnant and giving birth to a healthy, living, human
child with the help of ART or IUI.
SEC. 103. DEFINITIONS.
In this title:
(1) Assisted reproductive technology; art.--The term
``assisted reproductive technology'' or ``ART'' means any
treatment or procedure that includes the handling of human eggs
or embryos to help achieve a pregnancy, including in vitro
fertilization, egg or embryo cryopreservation, and egg or
embryo donation. Such term includes any medication related to
such a treatment or procedure.
(2) Health care provider.--The term ``health care
provider'' means any entity or individual (including any
physician, nurse practitioner, physician assistant, pharmacist,
health care support personnel, or clinical staff) that--
(A) is engaged or seeks to engage in the delivery
of ART or IUI, including through the provision of
evidence-based information, counseling, referrals, or
items and services that relate to, aid in, or provide
ART or IUI; and
(B) if required by State law to be licensed,
certified, or otherwise authorized to engage in the
delivery of ART or IUI--
(i) is so licensed, certified, or otherwise
authorized; or
(ii) would be so licensed, certified, or
otherwise authorized but for the fact that the
individual or entity has provided, is
providing, or plans to provide, ART or IUI in
accordance with section 104.
(3) Health insurance issuer.--The term ``health insurance
issuer'' has the meaning given such term in section 2791(b) of
the Public Health Service Act (42 U.S.C. 300gg-91(b)).
(4) Intrauterine insemination; iui.--The term
``intrauterine insemination'' or ``IUI'' means a procedure that
places sperm directly into an individual's uterus at the time
of the individual's ovulation to increase the chances of
fertilization. Such term includes any medication associated
with such a procedure.
(5) Manufacturer.--The term ``manufacturer'' means the
manufacturer of a drug or device approved, cleared, authorized,
or licensed under section 505, 510(k), 513(f)(2), or 515 of the
Federal Food, Drug, and Cosmetic Act (21 U.S.C. 355, 360(k),
360c(f)(2), 360e) or section 351 of the Public Health Service
Act (42 U.S.C. 262), or otherwise legally marketed.
(6) State.--The term ``State'' includes each of the 50
States, the District of Columbia, each territory and possession
of the United States, and any political subdivision thereof.
SEC. 104. RIGHT TO ASSISTED REPRODUCTIVE TECHNOLOGY AND INTRAUTERINE
INSEMINATION RIGHTS.
(a) General Rule.--
(1) Individual rights.--An individual has a statutory right
under this title, without prohibition, limitation,
interference, or impediment, to the extent that such
prohibition, limitation, interference, or impediment in any way
or degree obstructs, delays, or affects commerce over which the
Federal Government has jurisdiction, to--
(A) receive ART or IUI from a health care provider;
(B) continue or complete an ongoing ART or IUI
service previously initiated by a health care provider;
(C) make decisions and arrangements regarding the
donation, testing, use, storage, or disposition of
reproductive genetic material, such as oocytes, sperm,
fertilized eggs, and embryos; and
(D) establish contractual agreements with a health
care provider relating to the health care provider's
services in handling, testing, storing, shipping, and
disposing of the individual's reproductive genetic
material.
(2) Health care provider rights.--A health care provider
has a statutory right under this title, without prohibition,
limitation, interference, or impediment, to the extent that
such prohibition, limitation, interference, or impediment in
any way or degree obstructs, delays, or affects commerce over
which the Federal Government has jurisdiction, to--
(A) provide, or assist with the provision of, ART
or IUI;
(B) continue or complete the provision of, or
assistance with, ART or IUI that was lawful when
commenced;
(C) provide for, or assist with, the testing, use,
storage, or disposition of reproductive genetic
material, such as oocytes, sperm, fertilized eggs, and
embryos; and
(D) establish contractual agreements with
individuals or manufacturers relating to the health
care provider's services in handling, testing, storing,
shipping, and disposing of the individual's
reproductive genetic material.
(3) Health insurance issuer rights.--A health insurance
issuer has a statutory right under this title, without
prohibition, limitation, interference, or impediment, to the
extent that such prohibition, limitation, interference, or
impediment in any way or degree obstructs, delays, or affects
commerce over which the Federal Government has jurisdiction, to
cover the provision of ART or IUI.
(4) Manufacturer rights.--A manufacturer of a drug or
device that is approved, cleared, authorized, or licensed under
section 505, 510(k), 513(f)(2), or 515 of the Federal Food,
Drug, and Cosmetic Act (21 U.S.C. 355; 360(k); 360c(f)(2);
360e) or section 351 of the Public Health Service Act (42
U.S.C. 262) or otherwise legally marketed and intended for use
in the provision of ART or IUI, including the storage or
transport of oocytes, gametes, fertilized eggs, and embryos,
has a statutory right under this title, without prohibition,
limitation, interference, or impediment, to the extent that
such prohibition, limitation, interference, or impediment in
any way or degree obstructs, delays, or affects commerce over
which the Federal Government has jurisdiction, to manufacture,
import, market, sell, and distribute such drug or device.
(b) State Regulation of Medicine.--The enforcement of State health
and safety law regarding medical facilities or health care providers
does not constitute a violation of subsection (a) if--
(1) such regulations are consistent with guidance from the
American Society for Reproductive Medicine for providing ART or
IUI; and
(2) the safety or health objective cannot be advanced by a
different means that does not prohibit, limit, interfere with,
or impede the rights described in subsection (a).
(c) Enforcement.--
(1) The attorney general.--
(A) In general.--The Attorney General may commence
a civil action on behalf of the United States against
any State; an individual, employee, official, agency
head, contractor, organization, or instrumentality
acting for, or on behalf of, such a State; or any
individual acting under the color of, or pursuant to,
State law, that implements, enforces, or threatens to
enforce a limitation or requirement that prohibits,
limits, interferes with, or impedes the statutory
rights of an individual, a health care provider, a
health insurance issuer, or a manufacturer under
subsection (a).
(B) Effect of violations.--The court shall hold
unlawful and set aside a limitation or requirement
described in subparagraph (A) if it is in violation of
subsection (a).
(2) Private right of action.--
(A) In general.--Any individual or entity adversely
affected by an alleged violation of subsection (a) may
commence a civil action against an individual,
employee, official, agency head, contractor,
organization, or instrumentality acting for, or on
behalf of, such a State that enacts, implements, or
enforces a limitation or requirement that prohibits,
limits, interferes with, or impedes the statutory
rights of an individual, a health care provider, a
health insurance issuer, or a manufacturer under
subsection (a).
(B) Effect of violations.--The court shall hold
unlawful and enjoin a limitation or requirement
described in subparagraph (A) if it is in violation of
subsection (a).
(3) Health care provider.--
(A) In general.--A health care provider may
commence a civil action for relief on such provider's
own behalf, on behalf of the provider's staff, or on
behalf of the provider's patients who are or may be
adversely affected by an alleged violation of
subsection (a).
(B) Effect of violations.--The court shall hold
unlawful and enjoin a limitation or requirement
described in subparagraph (A) if it is in violation of
subsection (a).
(4) Equitable relief.--In any action under this section,
the court may award appropriate equitable relief, including
temporary, preliminary, or permanent injunctive relief.
(5) Costs.--
(A) In general.--In any action under this section,
the court shall award costs of litigation, as well as
reasonable attorney's fees, to any prevailing
plaintiff.
(B) Liability of plaintiffs.--A plaintiff shall not
be liable to a defendant for costs or attorney's fees
in any non-frivolous action under this section unless
such costs or attorney's fees are imposed by the court
as part of sanctions for violations committed during
the discovery process.
(6) Jurisdiction.--The district courts of the United States
shall have jurisdiction over proceedings under this section and
shall exercise the same without regard to whether the party
aggrieved shall have exhausted any administrative or other
remedies that may be provided for by law.
(7) Right to remove.--
(A) In general.--Any party shall have a right to
remove an action brought under this subsection to the
district court of the United States for the district
and division embracing the place where such action is
pending.
(B) Review.--An order remanding the case to the
State court from which it was removed under this
paragraph is immediately reviewable by appeal or
otherwise.
(d) Regulations.--Not later than 180 days after the date of
enactment of this Act, the Secretary of Health and Human Services shall
promulgate regulations to carry out this section.
(e) Rules of Construction.--
(1) In general.--For purposes of this title, a State law,
or the administration, implementation, or enforcement of a
State law, constitutes a prohibition, limitation, interference,
or impediment on a health care provider providing, an
individual receiving, a health insurance issuer covering, or a
manufacturer marketing drugs or devices for ART or IUI, as
described in subsection 104, if the administration,
implementation, interpretation, or enforcement of such law has
an effect that--
(A) imposes requirements or limitations that are
inconsistent with providing, receiving, providing
health insurance coverage for, or providing drugs or
devices for ART or IUI or that otherwise violate the
purpose and requirements of this Act, which may
include--
(i) requiring that a health care provider
provide, and patients undertake, medically
unnecessary procedures and services, including
tests and procedures, providing medically
inaccurate information regarding ART or IUI, or
requiring additional unnecessary in-person
visits to a health care provider;
(ii) imposing limitations or requirements
concerning physical offices, clinics,
facilities, equipment, staffing, or hospital
transfer arrangements of facilities where ART
or IUI are provided, or the credentials or
hospital privileges or status of personnel at
such facilities; or
(iii) limiting a health care provider's
right or ability to provide, or a patient's
right to receive, continue or complete ART or
IUI, or imposing limitations that reduce the
efficacy of, ART or IUI, including limitations
on--
(I) retrieval of multiple eggs
during oocyte retrieval;
(II) intracytoplasmic sperm
injections to fertilize multiple human
eggs; and
(III) cryopreservation of one or
more eggs, sperm, or embryos if
determined appropriate by the health
care provider and patient;
(B) infringes, limits, or restricts the ability of
a health care provider, patient, health insurance
issuer, or manufacturer, to exercise or enforce their
statutory rights under this title on the basis of
marital status, sex (including sexual orientation and
gender identity) or any other protected class that is
covered by Federal law;
(C) limits a health care provider's or patient's
right or ability to determine the most appropriate
disposition of reproductive genetic material, including
by defining a gamete or embryo in such a way to limit
an individual's options for how their reproductive
genetic material should be handled;
(D) limits a health care provider's ability to
provide, or a patient's ability to receive, ART or IUI
via telemedicine;
(E) limits or prohibits a health care provider's
ability to provide, or a patient's ability to receive,
counseling regarding ART or IUI based on the residency
of the patient, or prohibits or limits the ability of
any individual to assist or support a patient seeking
ART or IUI;
(F) imposes requirements or limitations that compel
health care providers to provide, or patients to
receive, medically unnecessary care, or withhold
medically necessary care, including mandating the
transfer of embryos that a health care provider would
not reasonably expect, based on American Society for
Reproductive Medicine guidelines, to lead to a
pregnancy or a live birth; or
(G) limits a health care provider's right or
ability to prescribe or dispense, or a patient's right
or ability to receive or use, medications for ART or
IUI, unless such a limitation is generally applicable
to the prescription, dispensing, or distribution of
medications.
(2) Clarification.--The descriptions of specific State laws
that would violate the statutory rights and protections
described in paragraph (1) shall not be construed to limit
potential violations of the statutory rights and protections
under this title to only the restrictions and limitations
listed in paragraph (1), and potential violations of this title
may result from novel State restrictions and limitations that
are not listed under paragraph (1).
(3) Exclusion.--It shall not constitute a prohibition,
limitation, interference, or impediment to a health care
provider providing, an individual receiving, a health insurance
issuer covering, or a manufacturer marketing a drug or device
for purposes of, ART or IUI under this title for an entity to
act in compliance with the Food and Drug Administration's
regulation of drugs, devices, biological products, human cells,
tissues, or cellular or tissue-based products used in ART or
IUI.
SEC. 105. APPLICABILITY AND PREEMPTION.
(a) In General.--
(1) General application.--
(A) Effect on state law.--This title supersedes any
State law that is inconsistent with the statutory
rights established under this title and precludes the
implementation of such a law, whether statutory, common
law, or otherwise, and whether adopted before or after
the date of enactment of this Act.
(B) Prohibition.--No State shall administer,
implement, or enforce any law, rule, regulation,
standard, or other provision having the force and
effect of law that conflicts with any provision of this
title, notwithstanding any other provision of Federal
law.
(2) Exclusion.--Preemption of State law under paragraph (1)
does not apply to--
(A) State law regarding the resolution of disputes
between 2 individuals with rights described in section
104(a)(1) with respect to the same reproductive genetic
material, such as oocytes, sperm, fertilized eggs, and
embryos; or
(B) any other State law, to the extent that such
law does not conflict with this title and protects an
individual's right and ability to receive ART or IUI in
accordance with American Society for Reproductive
Medicine guidelines, including any such law that holds
a health care provider accountable for not providing
ART or IUI in accordance with such guidelines.
(3) Preservation of federal public health authorities.--
Nothing in this title shall have the effect of superseding,
negating, or limiting provisions of Federal law, including the
Federal Food, Drug, and Cosmetic Act (21 U.S.C. 301 et seq.) or
the Public Health Service Act (42 U.S.C. 201 et seq.), and
regulations promulgated under such statutes, with respect to
the regulation of drugs, devices, biological products, human
cells, tissues, or cellular or tissue-based products used in
ART or IUI.
(4) Preservation of hipaa rules.--Nothing in this title
shall have the effect of superseding, negating, or limiting the
provisions of the privacy, security, and breach notification
regulations in parts 160 and 164 of title 45, Code of Federal
Regulations (or successor regulations).
(5) Subsequently enacted federal legislation.--Federal
statutory law adopted after the date of the enactment of this
Act is subject to this title unless such law explicitly
excludes such application by reference to this title.
(b) Defense.--In any cause of action against an individual or
entity who is subject to a limitation or requirement that violates this
title, in addition to the remedies specified in section 104(b), this
title shall also apply to, and may be raised as a defense by, such an
individual or entity.
TITLE II--VETERAN FAMILIES HEALTH SERVICES
SEC. 200. SHORT TITLE.
This title may be cited as the ``Veteran Families Health Services
Act''.
Subtitle A--Reproductive and Fertility Preservation Assistance for
Members of the Uniformed Services
SEC. 201. DEFINITIONS.
In this subtitle:
(1) Active duty.--The term ``active duty'' has the meaning
given that term in section 101(18) of title 37, United States
Code.
(2) Assisted reproductive technology.--The term ``assisted
reproductive technology'' means any treatment or procedure that
includes the handling of human eggs or embryos to help achieve
a pregnancy, including in vitro fertilization, egg or embryo
cryopreservation, and egg or embryo donation. Such term
includes any medication related to such a treatment or
procedure.
(3) Intrauterine insemination.--The term ``intrauterine
insemination'' means a procedure that places sperm directly
into an individual's uterus at the time of the individual's
ovulation to increase the chances of fertilization. Such term
includes any medication associated with such a procedure.
(4) Uniformed services.--The term ``uniformed services''
has the meaning given that term in section 101(a)(5) of title
10, United States Code.
SEC. 202. PROVISION OF ASSISTED REPRODUCTIVE TECHNOLOGY, INTRAUTERINE
INSEMINATION, AND COUNSELING TO CERTAIN MEMBERS OF THE
UNIFORMED SERVICES AND SPOUSES, PARTNERS, AND GESTATIONAL
SURROGATES OF SUCH MEMBERS.
(a) Assisted Reproductive Technology and Counseling and
Intrauterine Insemination.--
(1) In general.--The Secretary of Defense shall make
available assisted reproductive technology, intrauterine
insemination, and counseling to a member of the uniformed
services or a spouse, partner, or gestational surrogate of such
a member.
(2) Eligibility for treatment and counseling.--Assisted
reproductive technology, intrauterine insemination, and
counseling shall be furnished under paragraph (1) without
regard to the sex, sex characteristics, gender identity, sexual
orientation, infertility diagnosis, or marital status of the
member of the uniformed services or their partner.
(3) In vitro fertilization.--In the case of in vitro
fertilization treatment furnished under paragraph (1), the
Secretary shall furnish to an individual under such paragraph--
(A) not more than three completed oocyte
retrievals; and
(B) unlimited embryo transfers.
(b) Procurement of Reproductive Genetic Material.--If a member of
the uniformed services is unable to provide their reproductive genetic
material, such as oocytes, sperm, fertilized eggs, and embryos, for
purposes of assisted reproductive technology or intrauterine
insemination under subsection (a), the Secretary shall, at the election
of such member, allow such member to receive assisted reproductive
technology or intrauterine insemination with donated reproductive
genetic material and pay or reimburse such member the reasonable costs
of procuring such material from a donor.
(c) Rules of Construction.--
(1) Impact on existing authority.--Nothing in this section
shall be construed to rescind the authority of the Secretary to
provide in vitro fertilization benefits pursuant to section
1074(c)(4) of title 10, United States Code.
(2) Sourcing of gestational surrogate or reproductive
genetic material.--Nothing in this section shall be construed
to require the Secretary--
(A) to find or certify a gestational surrogate for
a member of the uniformed services or to connect a
gestational surrogate with such a member; or
(B) to find or certify reproductive genetic
material, such as oocytes, sperm, fertilized eggs, and
embryos, from a donor for a member of the uniformed
services or to connect such a member with reproductive
genetic material from a donor.
(d) Definitions.--In this section:
(1) Gestational surrogate.--The term ``gestational
surrogate'' means an individual who agrees to attempt to become
pregnant through in vitro fertilization under a gestational
surrogacy agreement using gametes that are not the gametes of
that individual.
(2) Partner.--The term ``partner'', with respect to a
member of the uniformed services, means an individual selected
by the member who agrees to be a parent, with the member, of a
child born as a result of the use of any assisted reproductive
technology or intrauterine insemination under this section.
SEC. 203. ESTABLISHMENT OF FERTILITY PRESERVATION PROCEDURES FOR
MEMBERS OF THE UNIFORMED SERVICES ON ACTIVE DUTY.
(a) After an Injury or Illness.--The Secretary of Defense, acting
through the Assistant Secretary of Defense for Health Affairs, shall
establish procedures for the retrieval, cryopreservation, and storage
of reproductive genetic material, such as oocytes, sperm, fertilized
eggs, and embryos, as soon as medically appropriate, by the Department
of Defense or a private entity from a member of the uniformed services
in cases in which the fertility of such member is potentially
jeopardized as a result of an injury or illness incurred or aggravated
while serving on active duty in the uniformed services in order to
preserve the medical options of such member.
(b) Prior to Deployment or Certain Assignments.--The Secretary of
Defense shall provide members of the uniformed services on active duty
in the uniformed services with the opportunity to cryopreserve and
store their reproductive genetic material, such as oocytes, sperm,
fertilized eggs, and embryos, at a facility of the Department of
Defense or of a private entity, prior to--
(1) deployment to a combat zone; or
(2) a duty assignment that includes a hazardous assignment,
including--
(A) assignments resulting in exposure to
perfluoroalkyl or polyfluoroalkyl substances; and
(B) such other assignments as determined by the
Secretary.
(c) Period of Time.--
(1) In general.--The Secretary shall provide for the
cryopreservation and storage of reproductive genetic material
of any member of the uniformed services under this section in a
facility of the Department of Defense or of a private entity
and the transportation of such material, at no cost to the
member, until the date that is one year after the retirement,
separation, or release of the member from the uniformed
services.
(2) Notice of options following storage.--
(A) In general.--Upon the date of retirement,
separation, or release of any member who has
cryopreserved and stored genetic material under this
section, the Secretary shall notify such member that
the Department of Defense shall continue to provide for
the cryopreservation and storage of reproductive
genetic material for one year and that at the end of
such one-year period the reproductive genetic material
shall be handled as directed by the member in writing.
(B) Direction by member.--The direction of a member
under subparagraph (A) may be provided to the
Department of Defense or the private entity storing the
genetic material in a consent agreement or similar type
of form signed by the member prior to retrieval and
cryopreservation or, if applicable, a form that has
superseded the original consent agreement or similar
type of form that was signed by the member after the
cryopreservation but on or before the date that is one
year after the retirement, separation, or release of
the member from the uniformed services.
(d) Advance Medical Directive and Military Testamentary
Instrument.--A member of the uniformed services who is eligible to
cryopreserve and store their reproductive genetic material under this
section must complete an advance medical directive, as defined in
section 1044c(b) of title 10, United States Code, and a military
testamentary instrument, as defined in section 1044d(b) of such title,
that explicitly specifies whether such member consents to the
procedures described in subsection (a) and how any cryopreserved and
stored reproductive genetic material shall be handled if such member
dies or otherwise loses the capacity to consent to the use of their
cryopreserved and stored reproductive genetic material.
(e) Agreements.--
(1) Agreements with private entities.--To carry out this
section, the Secretary may enter into agreements with private
entities that provide cryopreservation, transportation, and
storage services for reproductive genetic material.
(2) No contractual or liability obligation for agreements
between private entities and members.--The United States shall
not be--
(A) considered a party to any agreement, consent
form, or other contractual arrangement or commitment
between a member of the uniformed services and a
private entity that provides cryopreservation,
transportation, and storage services for reproductive
genetic material; or
(B) responsible for the management of reproductive
genetic material cryopreserved or stored at a private
entity pursuant to such agreement, consent form, or
other contractual arrangement or commitment.
SEC. 204. ASSISTANCE WITH AND CONTINUITY OF CARE REGARDING REPRODUCTIVE
AND FERTILITY PRESERVATION SERVICES.
The Secretary of Defense shall ensure that employees of the
Department of Defense assist members of the uniformed services--
(1) in navigating the services provided under this
subtitle;
(2) in finding a provider that meets the needs of such
members with respect to such services; and
(3) in continuing the receipt of such services without
interruption during a permanent change of station for such
members.
SEC. 205. COORDINATION BETWEEN DEPARTMENT OF DEFENSE AND DEPARTMENT OF
VETERANS AFFAIRS ON FURNISHING OF ASSISTED REPRODUCTIVE
TECHNOLOGY, INTRAUTERINE INSEMINATION, AND COUNSELING.
(a) In General.--The Secretary of Defense and the Secretary of
Veterans Affairs shall share best practices and facilitate referrals,
as they consider appropriate, on the furnishing of assisted
reproductive technology, intrauterine insemination, and counseling to
individuals eligible for the receipt of such counseling and services
from the Secretaries.
(b) Memorandum of Understanding.--The Secretary of Defense and the
Secretary of Veterans Affairs shall enter into a memorandum of
understanding providing that the Secretary of Defense will ensure
access by the Secretary of Veterans Affairs to reproductive genetic
material, such as oocytes, sperm, fertilized eggs, and embryos, of
veterans stored by the Department of Defense for purposes of furnishing
assisted reproductive technology and intrauterine insemination under
section 1720M of title 38, United States Code, as added by section
212(a).
SEC. 206. REGULATIONS.
Not later than two years after the date of the enactment of this
Act, the Secretary of Defense shall prescribe regulations to carry out
this subtitle.
Subtitle B--Reproductive Assistance for Veterans
SEC. 211. INCLUSION OF ASSISTED REPRODUCTIVE TECHNOLOGY, INTRAUTERINE
INSEMINATION, AND COUNSELING UNDER THE DEFINITION OF
MEDICAL SERVICES IN TITLE 38.
Section 1701(6) of title 38, United States Code, is amended by
adding at the end the following new subparagraph:
``(J) Assisted reproductive technology,
intrauterine insemination, and counseling under section
1720M of this title.''.
SEC. 212. ASSISTED REPRODUCTIVE TECHNOLOGY, INTRAUTERINE INSEMINATION,
AND COUNSELING FOR CERTAIN VETERANS AND SPOUSES,
PARTNERS, AND GESTATIONAL SURROGATES OF SUCH VETERANS.
(a) In General.--Subchapter II of chapter 17 of title 38, United
States Code, is amended by adding at the end the following new section:
``Sec. 1720M. Assisted reproductive technology, intrauterine
insemination, and counseling for certain veterans and
spouses, partners, and gestational surrogates of such
veterans
``(a) Requirement.--
``(1) In general.--Notwithstanding any other provision of
law, including the surrogacy laws of any State, the Secretary
shall furnish assisted reproductive technology, intrauterine
insemination, and counseling for the benefit of a covered
veteran to the veteran and the spouse, partner, gamete donor,
or gestational surrogate of the veteran if the veteran, and the
spouse, partner, gamete donor, or gestational surrogate of the
veteran, as applicable, each provide informed consent for such
assisted reproductive technology, intrauterine insemination,
and counseling, including for each cycle of treatment
authorized under this section, through a process prescribed by
the Secretary.
``(2) Provision of treatment and counseling.--Assisted
reproductive technology, intrauterine insemination, and
counseling shall be furnished under paragraph (1) without
regard to the sex, sexual characteristics, gender identity,
sexual orientation, infertility diagnosis, or marital status of
the covered veteran or their partner.
``(3) In vitro fertilization.--In the case of in vitro
fertilization treatment furnished under paragraph (1), the
Secretary shall furnish to an individual under such paragraph--
``(A) not more than three completed oocyte
retrievals; and
``(B) unlimited embryo transfers.
``(4) Copayment.--The Secretary shall only furnish assisted
reproductive technology, intrauterine insemination, and
counseling under paragraph (1) to a covered veteran who is
required to pay to the United States a copayment amount as a
condition for the receipt of hospital care, medical services,
or medications under this chapter if the covered veteran agrees
to pay such applicable copayment amount to the United States
for such assisted reproductive technology and counseling.
``(b) Procurement of Reproductive Genetic Material.--
``(1) In general.--If a covered veteran is unable to
provide their reproductive genetic material for purposes of
assisted reproductive technology or intrauterine insemination
under subsection (a), the Secretary shall, at the election of
such veteran--
``(A) allow such veteran to receive assisted
reproductive technology or intrauterine insemination
with donated reproductive genetic material, if the
donor provides informed consent for use of such
material; and
``(B) pay or reimburse the veteran, donor, or a
party acting on behalf of the donor the reasonable
costs of procuring such material from the donor.
``(2) Other expenses.--The Secretary may pay or reimburse a
covered veteran a reasonable amount for personal travel and
incidental expenses associated with procuring material from a
donor under paragraph (1).
``(c) Outreach and Training.--The Secretary shall carry out an
outreach and training program to ensure veterans and health care
providers of the Department are aware of--
``(1) the availability of and eligibility requirements for
assisted reproductive technology, intrauterine insemination,
and counseling under this section; and
``(2) any changes to assisted reproductive technology,
intrauterine insemination, and counseling covered under this
section.
``(d) Ownership, Use, or Disposition of Reproductive Genetic
Material.--
``(1) In general.--Issues or disputes regarding use or
disposition of reproductive genetic material under this section
shall be the sole responsibility of the covered veteran, the
spouse or partner of the covered veteran, as applicable, and
the private facility storing such material.
``(2) Agreement regarding donated reproductive genetic
material.--As a condition of the use of donated gametes or
embryos under this section, the third-party donor and a
provider of assisted reproductive technology or intrauterine
insemination that has entered into a contract or agreement with
the Secretary to provide assisted reproductive technology or
intrauterine insemination under this section shall enter into
an arrangement or agreement governing the terms of the
donation, including how any remaining cryopreserved and stored
reproductive genetic material will be handled once a covered
veteran has exhausted the assisted reproductive technology or
intrauterine insemination services available under this
section, unless the veteran or the spouse or partner of the
veteran has agreed to assume liability for the continued
preservation of any remaining gametes or embryos and the
Department is not party to the arrangement or agreement for
such continued preservation.
``(3) Role of department.--The role of the Secretary under
this section is limited to furnishing assisted reproductive
technology, intrauterine insemination, and counseling required
under this section when requested by a covered veteran and
determined necessary by the Secretary.
``(4) Ownership and custody of reproductive genetic
material.--The Secretary will not have ownership or custody of
any reproductive genetic material obtained pursuant to
treatment under this section and will not be involved in
disputes between or among any parties with respect to such
material.
``(e) Rule of Construction.--Nothing in this section shall be
construed to require the Secretary--
``(1) to find or certify a gestational surrogate for a
covered veteran or to connect a gestational surrogate with a
covered veteran; or
``(2) to furnish maternity care to a covered veteran or
spouse, partner, or gestational surrogate of a covered veteran
beyond what is otherwise required or authorized by law.
``(f) Definitions.--In this section:
``(1) The term `assisted reproductive technology' means any
treatment or procedure that includes the handling of human eggs
or embryos to help achieve a pregnancy, including in vitro
fertilization, egg or embryo cryopreservation, and egg or
embryo donation. Such term includes any medication related to
such a treatment or procedure.
``(2) The term `covered veteran' means a veteran who is
enrolled in the system of annual patient enrollment established
under section 1705(a) of this title.
``(3) The term `gestational surrogate' means an individual
who agrees to attempt to become pregnant through in vitro
fertilization under a gestational surrogacy agreement using
gametes that are not the gametes of that individual.
``(4) The term `intrauterine insemination' means a
procedure that places sperm directly into an individual's
uterus at the time of the individual's ovulation to increase
the chances of fertilization. Such term includes any medication
associated with such a procedure.
``(5) The term `partner', with respect to a covered
veteran, means an individual selected by the veteran who agrees
to be a parent, with the veteran, of a child born as a result
of the use of any assisted reproductive technology or
intrauterine insemination under this section.''.
(b) Clerical Amendment.--The table of sections at the beginning of
chapter 17 of such title is amended by inserting after the item
relating to section 1720L the following new item:
``1720M. Assisted reproductive technology, intrauterine insemination,
and counseling for certain veterans and
spouses, partners, and gestational
surrogates of such veterans.''.
(c) Sunset of Existing Authority.--The authority under section
234(a)(1) of the Military Construction, Veterans Affairs, and Related
Agencies Appropriations Act, 2024 (division A of Public Law 118-42), or
any similar authority subsequently enacted by law, shall cease on the
effective date of regulations prescribed to carry out section 1720M of
title 38, United States Code, as added by subsection (a).
SEC. 213. ASSISTANCE WITH AND CONTINUITY OF CARE REGARDING REPRODUCTIVE
AND FERTILITY PRESERVATION SERVICES.
The Secretary of Veterans Affairs shall ensure that employees of
the Department of Veterans Affairs assist veterans--
(1) in navigating the services provided under this subtitle
and the amendments made by this subtitle;
(2) in finding a provider that meets the needs of such
veterans with respect to such services; and
(3) in continuing the receipt of such services without
interruption if such veterans move to a different geographic
location.
SEC. 214. COORDINATION OF REPRODUCTION AND FERTILITY RESEARCH FOR
VETERANS.
(a) In General.--Subchapter II of chapter 73 of title 38, United
States Code, is amended by adding at the end the following new section:
``Sec. 7330E. Coordination of reproduction and fertility research for
veterans
``(a) Coordination of Research Required.--The Secretary shall
coordinate with the Secretary of Defense and the Secretary of Health
and Human Services to conduct research to improve the ability of the
Department of Veterans Affairs to meet the long-term reproductive
health care needs of veterans who have a condition that affects the
ability of the individual to reproduce.
``(b) Dissemination of Information.--The Secretary shall ensure
that information produced by the research under this section that may
be useful for other activities of the Department is disseminated
throughout the Department.''.
(b) Clerical Amendment.--The table of sections at the beginning of
chapter 73 of such title is amended by inserting after the item
relating to section 7330D the following new item:
``7330E. Coordination of reproduction and fertility research for
veterans.''.
TITLE III--ACCESS TO ASSISTED REPRODUCTIVE TECHNOLOGY AND INTRAUTERINE
INSEMINATION
SEC. 301. SHORT TITLE.
This title may be cited as the ``Access to Fertility Treatment and
Care Act''.
SEC. 302. STANDARDS RELATING TO BENEFITS FOR ASSISTED REPRODUCTIVE
TECHNOLOGY AND INTRAUTERINE INSEMINATION.
(a) In General.--
(1) PHSA.--Part D of title XXVII of the Public Health
Service Act (42 U.S.C. 300gg-111 et seq.) is amended by adding
at the end the following:
``SEC. 2799A-12. STANDARDS RELATING TO BENEFITS FOR ASSISTED
REPRODUCTIVE TECHNOLOGY AND INTRAUTERINE INSEMINATION.
``(a) In General.--A group health plan or a health insurance issuer
offering group or individual health insurance coverage shall provide
coverage for assisted reproductive technology and intrauterine
insemination.
``(b) Definition.--
``(1) Assisted reproductive technology; art.--The term
`assisted reproductive technology' or `ART' means any treatment
or procedure that includes the handling of human eggs or
embryos to help achieve a pregnancy, including in vitro
fertilization, egg or embryo cryopreservation, and egg or
embryo donation. Such term includes any medication related to
such a treatment or procedure.
``(2) Intrauterine insemination; iui.--The term
`intrauterine insemination' or `IUI' means a procedure that
places sperm directly into an individual's uterus at the time
of the individual's ovulation to increase the chances of
fertilization. Such term includes any medication associated
with such a procedure.
``(c) Required Coverage.--A group health plan and a health
insurance issuer offering group or individual health insurance coverage
shall provide coverage for ART and IUI determined appropriate by the
health care provider, regardless of whether the participant,
beneficiary, or enrollee receiving ART or IUI has been diagnosed with
infertility as defined by the American Society for Reproductive
Medicine, if the ART or IUI is performed at, or prescribed by, a
licensed medical facility.
``(d) Limitation.--Cost-sharing, including deductibles and
coinsurance, or other limitations for ART or IUI may not be imposed
with respect to ART or IUI required to be covered under subsection (c)
to the extent that such cost-sharing exceeds the cost-sharing applied
to other medical services under the group health plan or health
insurance coverage or such other limitations are different from
limitations imposed with respect to such medical services, except where
such limitation is more favorable with respect to ART or IUI. The
Secretary shall promulgate interim final regulations to carry out this
subsection, notwithstanding the notice and comment requirements of
section 553 of title 5, United States Code.
``(e) Prohibitions.--A group health plan and a health insurance
issuer offering group or individual health insurance coverage may not--
``(1) provide incentives (monetary or otherwise) to a
participant, beneficiary, or enrollee to encourage such
participant, beneficiary, or enrollee not to seek or obtain ART
or IUI to which such participant, beneficiary, or enrollee is
entitled under this section or to providers to induce such
providers not to provide medically appropriate ART or IUI to
participants, beneficiaries, or enrollees;
``(2) prohibit a provider from discussing with a
participant, beneficiary, or enrollee ART or IUI relating to
this section;
``(3) penalize or otherwise reduce or limit the
reimbursement of a provider because such provider provided ART
or IUI to a qualified participant, beneficiary, or enrollee in
accordance with this section; or
``(4) on the ground prohibited under title VI of the Civil
Rights Act of 1964, title IX of the Education Amendments of
1972, the Age Discrimination Act of 1975, section 504 of the
Rehabilitation Act of 1973, or section 1557 of the Patient
Protection and Affordable Care Act, exclude any individual from
coverage in accordance with this section, or discriminate
against any individual with respect to such coverage.
``(f) Rule of Construction.--Nothing in this section shall be
construed to require a participant, beneficiary, or enrollee to undergo
ART or IUI.
``(g) Notice.--A group health plan and a health insurance issuer
offering group or individual health insurance coverage shall provide
notice to each participant, beneficiary, and enrollee under such plan
or coverage regarding the coverage required by this section in
accordance with regulations promulgated by the Secretary. Such notice
shall be in writing and prominently positioned in any literature or
correspondence made available or distributed by the plan or issuer and
shall be transmitted--
``(1) not later than the earlier of--
``(A) in the first standard mailing made by the
plan or issuer to the participant, beneficiary, or
enrollee following the effective date of such
regulations;
``(B) as part of any yearly informational packet
sent to the participant, beneficiary, or enrollee; or
``(C) January 1, 2027;
``(2) in the case of a participant, beneficiary, or
enrollee not enrolled in the plan or coverage on the date of
transmission under paragraph (1), upon initial enrollment of
such participant, beneficiary, or enrollee; and
``(3) on an annual basis after the transmission under
paragraph (1) or (2).
``(h) Level and Type of Reimbursements.--Nothing in this section
shall be construed to prevent a group health plan or a health insurance
issuer offering group or individual health insurance coverage from
negotiating the level and type of reimbursement with a provider for
care provided in accordance with this section.''.
(2) ERISA.--
(A) In general.--Subpart B of part 7 of subtitle B
of title I of the Employee Retirement Income Security
Act of 1974 (29 U.S.C. 1185 et seq.) is amended by
adding at the end the following:
``SEC. 727. STANDARDS RELATING TO BENEFITS FOR ASSISTED REPRODUCTIVE
TECHNOLOGY AND INTRAUTERINE INSEMINATION.
``(a) In General.--A group health plan or a health insurance issuer
offering group health insurance coverage shall provide coverage for
assisted reproductive technology and intrauterine insemination.
``(b) Definitions.--
``(1) Assisted reproductive technology or art.--The term
`assisted reproductive technology' or `ART' means any treatment
or procedure that includes the handling of human eggs or
embryos to help achieve a pregnancy, including in vitro
fertilization, egg or embryo cryopreservation, and egg or
embryo donation. Such term includes any medication related to
such a treatment or procedure.
``(2) Intrauterine insemination; iui.--The term
`intrauterine insemination' or `IUI' means a procedure that
places sperm directly into an individual's uterus at the time
of the individual's ovulation to increase the chances of
fertilization. Such term includes any medication associated
with such a procedure.
``(c) Required Coverage.--A group health plan and a health
insurance issuer offering group health insurance coverage shall provide
coverage for ART and IUI determined appropriate by the health care
provider, regardless of whether the participant or beneficiary
receiving ART or IUI has been diagnosed with infertility as defined by
the American Society for Reproductive Medicine, if the ART or IUI is
performed at, or prescribed by, a licensed medical facility.
``(d) Limitation.--Cost-sharing, including deductibles and
coinsurance, or other limitations for ART or IUI may not be imposed
with respect to ART or IUI required to be covered under subsection (c)
to the extent that such cost-sharing exceeds the cost-sharing applied
to other medical services under the group health plan or health
insurance coverage or such other limitations are different from
limitations imposed with respect to such medical services, except where
such limitation is more favorable with respect to ART or IUI. The
Secretary shall promulgate interim final regulations to carry out this
subsection, notwithstanding the notice and comment requirements of
section 553 of title 5, United States Code.
``(e) Prohibitions.--A group health plan and a health insurance
issuer offering group health insurance coverage may not--
``(1) provide incentives (monetary or otherwise) to a
participant or beneficiary to encourage such participant or
beneficiary not to seek or obtain ART or IUI to which such
participant or beneficiary is entitled under this section or to
providers to induce such providers not to provide medically
appropriate ART or IUI to participants or beneficiaries;
``(2) prohibit a provider from discussing with a
participant or beneficiary ART or IUI relating to this section;
``(3) penalize or otherwise reduce or limit the
reimbursement of a provider because such provider provided ART
or IUI to a qualified participant or beneficiary in accordance
with this section; or
``(4) on the ground prohibited under title VI of the Civil
Rights Act of 1964 (42 U.S.C. 2000d et seq.), title IX of the
Education Amendments of 1972 (20 U.S.C. 1681 et seq.), the Age
Discrimination Act of 1975 (42 U.S.C. 6101 et seq.), section
504 of the Rehabilitation Act of 1973 (29 U.S.C. 794), or
section 1557 of the Patient Protection and Affordable Care Act
(42 U.S.C. 18116), exclude any individual from coverage in
accordance with this section, or discriminate against any
individual with respect to such coverage.
``(f) Rule of Construction.--Nothing in this section shall be
construed to require a participant or beneficiary to undergo ART or
IUI.
``(g) Notice.--A group health plan and a health insurance issuer
offering group health insurance coverage shall provide notice to each
participant and beneficiary under such plan or coverage regarding the
coverage required by this section in accordance with regulations
promulgated by the Secretary. Such notice shall be in writing and
prominently positioned in any literature or correspondence made
available or distributed by the plan or issuer and shall be
transmitted--
``(1) not later than the earlier of--
``(A) in the first standard mailing made by the
plan or issuer to the participant or beneficiary
following the effective date of such regulations;
``(B) as part of any yearly informational packet
sent to the participant or beneficiary; or
``(C) January 1, 2027;
``(2) in the case of a participant or beneficiary not
enrolled in the plan or coverage on the date of transmission
under paragraph (1), upon initial enrollment of such
participant or beneficiary; and
``(3) on an annual basis after the transmission under
paragraph (1) or (2).
``(h) Level and Type of Reimbursements.--Nothing in this section
shall be construed to prevent a group health plan or a health insurance
issuer offering group health insurance coverage from negotiating the
level and type of reimbursement with a provider for care provided in
accordance with this section.''.
(B) Clerical amendment.--The table of contents in
section 1 of the Employee Retirement Income Security
Act of 1974 (29 U.S.C. 1001 et seq.) is amended by
inserting after the item relating to section 726 the
following new item:
``Sec. 727. Standards relating to benefits for assisted reproductive
technology and intrauterine
insemination.''.
(3) IRC.--
(A) In general.--Subchapter B of chapter 100 of the
Internal Revenue Code of 1986 is amended by adding at
the end the following:
``SEC. 9827. STANDARDS RELATING TO BENEFITS FOR ASSISTED REPRODUCTIVE
TECHNOLOGY AND INTRAUTERINE INSEMINATION.
``(a) In General.--A group health plan shall provide coverage for
assisted reproductive technology and intrauterine insemination.
``(b) Definition.--
``(1) Assisted reproductive technology; art.--The term
`assisted reproductive technology' or `ART' means any treatment
or procedure that includes the handling of human eggs or
embryos to help achieve a pregnancy, including in vitro
fertilization, egg or embryo cryopreservation, and egg or
embryo donation. Such term includes any medication related to
such a treatment or procedure.
``(2) Intrauterine insemination; iui.--The term
`intrauterine insemination' or `IUI' means a procedure that
places sperm directly into an individual's uterus at the time
of the individual's ovulation to increase the chances of
fertilization. Such term includes any medication associated
with such a procedure.
``(c) Required Coverage.--A group health plan shall provide
coverage for ART and IUI determined appropriate by the health care
provider, regardless of whether the participant or beneficiary
receiving ART or IUI has been diagnosed with infertility as defined by
the American Society for Reproductive Medicine, if the ART or IUI is
performed at, or prescribed by, a licensed medical facility.
``(d) Limitation.--Cost-sharing, including deductibles and
coinsurance, or other limitations for ART or IUI may not be imposed
with respect to ART or IUI required to be covered under subsection (c)
to the extent that such cost-sharing exceeds the cost-sharing applied
to other medical services under the group health plan or health
insurance coverage or such other limitations are different from
limitations imposed with respect to such medical services, except where
such limitation is more favorable with respect to ART or IUI. The
Secretary shall promulgate interim final regulations to carry out this
subsection, notwithstanding the notice and comment requirements of
section 553 of title 5, United States Code.
``(e) Prohibitions.--A group health plan may not--
``(1) provide incentives (monetary or otherwise) to a
participant or beneficiary to encourage such participant or
beneficiary not to seek or obtain ART or IUI to which such
participant or beneficiary is entitled under this section or to
providers to induce such providers not to provide medically
appropriate ART or IUI to participants or beneficiaries;
``(2) prohibit a provider from discussing with a
participant or beneficiary ART or IUI relating to this section;
``(3) penalize or otherwise reduce or limit the
reimbursement of a provider because such provider provided ART
or IUI to a qualified participant or beneficiary in accordance
with this section; or
``(4) on the ground prohibited under title VI of the Civil
Rights Act of 1964 (42 U.S.C. 2000d et seq.), title IX of the
Education Amendments of 1972 (20 U.S.C. 1681 et seq.), the Age
Discrimination Act of 1975 (42 U.S.C. 6101 et seq.), section
504 of the Rehabilitation Act of 1973 (29 U.S.C. 794), or
section 1557 of the Patient Protection and Affordable Care Act
(42 U.S.C. 18116), exclude any individual from coverage in
accordance with this section, or discriminate against any
individual with respect to such coverage.
``(f) Rule of Construction.--Nothing in this section shall be
construed to require a participant or beneficiary to undergo ART or
IUI.
``(g) Notice.--A group health plan shall provide notice to each
participant and beneficiary under such plan regarding the coverage
required by this section in accordance with regulations promulgated by
the Secretary. Such notice shall be in writing and prominently
positioned in any literature or correspondence made available or
distributed by the plan and shall be transmitted--
``(1) not later than the earlier of--
``(A) in the first standard mailing made by the
plan to the participant or beneficiary following the
effective date of such regulations;
``(B) as part of any yearly informational packet
sent to the participant or beneficiary; or
``(C) January 1, 2027;
``(2) in the case of a participant or beneficiary not
enrolled in the plan on the date of transmission under
paragraph (1), upon initial enrollment of such participant or
beneficiary; and
``(3) on an annual basis after the transmission under
paragraph (1) or (2).
``(h) Level and Type of Reimbursements.--Nothing in this section
shall be construed to prevent a group health plan from negotiating the
level and type of reimbursement with a provider for care provided in
accordance with this section.''.
(B) Clerical amendment.--The table of sections for
subchapter B of chapter 100 of the Internal Revenue
Code of 1986 is amended by adding at the end the
following new item:
``Sec. 9827. Standards relating to benefits for assisted reproductive
technology and intrauterine
insemination.''.
(b) Conforming Amendments.--
(1) PHSA.--Section 2724(c) of the Public Health Service Act
(42 U.S.C. 300gg-23(c)) is amended by striking ``section 2704''
and inserting ``sections 2704 and 2799A-12''.
(2) ERISA.--Section 731(c) of the Employee Retirement
Income Security Act of 1974 (29 U.S.C. 1191(c)) is amended by
striking ``section 711'' and inserting ``sections 711 and
727''.
(c) Effective Dates.--
(1) In general.--The amendments made by subsections (a) and
(b) shall apply for plan years beginning on or after the date
that is 6 months after the date of enactment of this Act.
(2) Collective bargaining exception.--
(A) In general.--In the case of a group health plan
maintained pursuant to one or more collective
bargaining agreements between employee representatives
and one or more employers ratified before the date of
enactment of this Act, the amendments made by
subsection (a) shall not apply to plan years beginning
before the later of--
(i) the date on which the last collective
bargaining agreements relating to the plan
terminates (determined without regard to any
extension thereof agreed to after the date of
enactment of this Act), or
(ii) the date occurring 6 months after the
date of the enactment of this Act.
(B) Clarification.--For purposes of subparagraph
(A), any plan amendment made pursuant to a collective
bargaining agreement relating to the plan which amends
the plan solely to conform to any requirement added by
subsection (a) shall not be treated as a termination of
such collective bargaining agreement.
SEC. 303. REQUIREMENT FOR STATE MEDICAID PLANS TO PROVIDE MEDICAL
ASSISTANCE FOR ASSISTED REPRODUCTIVE TECHNOLOGY AND
INTRAUTERINE INSEMINATION.
(a) In General.--Section 1905 of the Social Security Act (42 U.S.C.
1396d) is amended--
(1) in subsection (a)(4)(C), by inserting ``(which shall
include assisted reproductive technology (ART) and intrauterine
insemination (IUI) provided in accordance with subsection
(ll))'' after ``family planning services and supplies''; and
(2) by adding at the end the following new subsection:
``(ll) Requirements for Coverage of Assisted Reproductive
Technology and Intrauterine Insemination .--For purposes of subsection
(a)(4)(C), a State shall ensure that the medical assistance provided
under the State plan (or waiver of such plan) for assisted reproductive
technology (ART) and intrauterine insemination (IUI) complies with the
requirements of section 2799A-12(b) of the Public Health Service Act in
the same manner as such requirements and limitations apply to health
insurance coverage offered by a group health plan or health insurance
issuer.''.
(b) Technical Amendment.--Section 1903(a)(5) of the Social Security
Act (42 U.S.C. 1396b(a)(5)) is amended by inserting ``described in
section 1905(a)(4)(C)'' after ``family planning services and
supplies''.
(c) Effective Date.--
(1) In general.--Except as provided in paragraph (2), the
amendments made by this section shall take effect on October 1,
2027.
(2) Delay permitted if state legislation required.--In the
case of a State plan approved under title XIX of the Social
Security Act which the Secretary of Health and Human Services
determines requires State legislation (other than legislation
appropriating funds) in order for the plan to meet the
additional requirement imposed by this section, the State plan
shall not be regarded as failing to comply with the
requirements of such title solely on the basis of the failure
of the plan to meet such additional requirement before the
first day of the first calendar quarter beginning after the
close of the first regular session of the State legislature
that ends after the 1-year period beginning with the date of
the enactment of this section. For purposes of the preceding
sentence, in the case of a State that has a 2-year legislative
session, each year of the session is deemed to be a separate
regular session of the State legislature.
SEC. 304. MEDICARE COVERAGE OF ASSISTED REPRODUCTIVE TECHNOLOGY AND
INTRAUTERINE INSEMINATION.
(a) Coverage.--Section 1861(s)(2) of the Social Security Act (42
U.S.C. 1395x(s)(2)) is amended--
(1) in subparagraph (JJ), by striking ``and'' at the end;
(2) in subparagraph (KK), by inserting ``and'' at the end;
and
(3) by adding at the end the following new subparagraph:
``(LL) assisted reproductive technology and intrauterine
insemination (as defined in section 2799A-12(b) of the Public
Health Service Act);''.
(b) Payment and Waiver of Coinsurance.--Section 1833(a)(1) of the
Social Security Act (42 U.S.C. 1395l(a)(1)) is amended--
(1) by striking ``and'' before ``(HH)''; and
(2) by inserting before the semicolon at the end the
following: ``, and (II) with respect to assisted reproductive
technology and intrauterine insemination (as described in
section 1861(s)(2)(LL)), the amount paid shall be equal to 100
percent of the lesser of the actual charge for the treatment or
the amount determined under the payment basis determined under
section 1848''.
(c) Waiver of Application of Deductible.--The first sentence of
section 1833(b) of the Social Security Act (42 U.S.C. 1395l(b)) is
amended--
(1) by striking ``, and (13)'' and inserting ``(13)''; and
(2) by striking ``1861(n)..'' and inserting ``1861(n), and
(14) such deductible shall not apply with respect to assisted
reproductive technology (as described in section
1861(s)(2)(LL).''.
(d) Payment Under Physician Fee Schedule.--Section 1848(j)(3) of
the Social Security Act (42 U.S.C. 1395w-4(j)(3)) is amended by
inserting ``(2)(LL)'' after ``risk assessment),''.
(e) Conforming Amendment Regarding Coverage.--Section 1862(a)(1)(A)
of the Social Security Act (42 U.S.C. 1395y(a)(1)(A)) is amended by
inserting ``, or assisted reproductive technology (as described in
section 1861(s)(2)(LL) and intrauterine insemination'' after
``1861(ddd)(1))''.
(f) Effective Date.--The amendments made by this section shall
apply to services furnished on or after January 1, 2027.
TITLE IV--FAMILY BUILDING FEHB FAIRNESS
SEC. 401. SHORT TITLE.
This title may be cited as the ``Family Building FEHB Fairness
Act''.
SEC. 402. ASSISTED REPRODUCTIVE TECHNOLOGY AND INTRAUTERINE
INSEMINATION BENEFITS.
(a) In General.--Section 8904 of title 5, United States Code, is
amended--
(1) in subsection (a)--
(A) in paragraph (1), by adding at the end the
following:
``(G) Assisted reproductive technology and
intrauterine insemination benefits.''; and
(B) in paragraph (2)--
(i) by redesignating subparagraph (F) as
subparagraph (G); and
(ii) by inserting after subparagraph (E)
the following:
``(F) Assisted reproductive technology and
intrauterine insemination benefits.''; and
(2) by adding at the end the following:
``(c) Definitions.--In this section, the terms `assisted
reproductive technology' and `intrauterine insemination' have the
meanings given such terms in section 103 of the Right to IVF Act of
2026.''.
(b) Effective Date.--The amendments made by this section shall take
effect on the date that is 1 year after the date of enactment of this
Act.
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